What can I do to look less tired and unhappy?

Question

I'm 37 and am getting told more and more that I look tired and unhappy. It's to the point where I'd rather not go out in public. I've tried under eye fillers 4 years ago, but the filler ended up migrating to bags, which are still evident today. I am therefore hesitant to try filler again, but I'm not sure what would help me look less tired. Mini face lift, buccal fat removal? Would any procedure help with the under eye area?

Thomas A. Mustoe, MD, FACS · Answer

It is hard to give any advice without looking a at pictures, but filler under the eyes can cause swelling.  Fat transfer under the eyes when done well gives a very natural aloearance but if you have excess skin or puffiness over the orbital rim ( malar puffs) the solution is more complex

Jason Emer, MD · Answer

"I suggest reaching out to an expert for a formal consultation. I like to recommend my patients start a combination of facial rejuvenation treatments.

1) Skincare with products and microneedling/PRP
2) PDT Light Therapy a few times per month with growth factors
3) Laser treatments like Clear + Brilliant regularly and others (Fraxel, Moxi, Viva, CO2, Erbium, Halo) a few times per year
4) Sculptra injections a few times per year for collagen production with fillers like Juvederm, Restylane, Belotero, Radiesse, and/or Bellafill
5) Thermage/Ultherapy for yearly skin tightening with or without PDO or cone-based Instalift threads for lifting
6) Botox every 2 to 3 months to stop movement lines and prevent lines at rest

Best, Dr. Emer."

Anil R. Shah, MD · Answer

Hello Rational9767! My name is Jessica, I am a physician assistant, and one of the providers at Shah Facial Plastics. I recommend trying the Morpheus8 radiofrequency treatment. This is a great treatment that helps to increase collagen production, tighten the skin, improve fine lines, minimize the pores, and helps to rejuvenate the appearance of the skin. I hope this helps!

Robert M. Lowen, MD · Answer

No pictures, no information.  But we can visualize what you mean. The sagging under the eyes makes you look prematurely older and tired.  This is an issue of either deflation with soft tissue sagging, or skin laxity  which can be accelerated by environmental exposure, e.g., sun. Bone structure in a flatter, less prominent cheek, allows the natural aging process to start earlier.
  The treatment is reversal of any and all of those factors:  fat grafting to the suborbital area to enhance the normal youthful cheek fullness and shorten the distance between the lower lid and cheek, which when elongated is a sign of aging.  Skin tightening might be  helpful, as in a lower lid blepharoplasty, but at 37 be careful with this, as trying to solve the problem with skin tightening instead of support from below you are subject to the complications of retraction of the lower lid.  Some laser treatments can have a benefit, such as fractional erbium or CO2 to tighten the skin non-surgically.

Steve Laverson, MD, FACS · Answer

In medicine and surgery, the proper treatment can only be determined by first correctly diagnosing the problem.  In your case, that means deciding with you in the mirror what features exactly are creating an impression and expression of fatigue and/or unhappiness.  It may be downturned corners of lips, upper or lower eyelids, and/or other features.  Without photo(s) it's impossible to know, and personal consultation is even better because correction of sad or tired features can be simulated in the office to know what changes will offer the most improvement.

Kenneth D. Steinsapir, MD · Answer

It is all too easy to be discouraged by services and surgery that seem to make you worse. Sometimes other life stressors combine and weigh us down. Don't get me wrong, addressing your cosmetic concerns will help you look and feel better. Still sometimes there is no substitute for professional mental health help. Think about this and remember that both approaches can be very helpful.

Your ancient under eye fillers are still there. I would recommend removing every bit of that product using the injectable enzyme hyaluronidase. You may benefit from the right filler service but the place to start is the removal of old treatments that accumulate volume over time and make us look older.

Michael I. Echavez, MD · Answer

There are different possible issues with the under eye area, and they have different treatment options.  If there are bags under the eyes, this is usually caused by protruding fat.  The most direct method of treating this would be with surgery to address the excess fat.  If there is not an issue with protruding fat, there are other treatment options to help tighten the skin.  Fillers can sometimes be used if there is a depression under the eyes.  Photos of you would be helpful to determine which treatment option might be best for you.

Zoran Potparic, MD · Answer

Unfortunately, without photos and/or in person evaluation it is impossible to give you an advise. In person consultation with a board certified plastic surgeon would be the best way to find some answers. Good luck.

William Portuese, MD · Answer

In order to give a determination about the best surgical procedures, a full set of facial photographs from all angles are going to be required. A trans- conjunctival lower blepharoplasty helps with fat bags in the lower lids, when they're significant enough to warrant surgery. Probably should have the fillers reversed before making any surgical determination.

What can I do to look less tired and unhappy?

Answers (9)

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